Did badly on Step I - want to do peds

[shaggy alfresco]

So I got my scores back and I did about 15 points worse than my NBME practice exam - my score 5 days out was 228 and I got a 213....

I'm on peds now, and I absolutely love it. I am thinking about doing Peds Heme/Onc or another peds sub-specialty. I am not sure which one yet but I'd like to keep my options open.

Obviously I am busting my butt to do as well as I can on the rotation but I'm afraid that my score will preclude me from going to a place that will allow me to do a fellowship. I am not looking for a super-academic career, so I don't need to do it at CHOP or anything. But I'd like to do it at an academic place where I'd have a shot at a couple sub-specialties and hopefully practicing in an environment where I can do some teaching.

How can I make myself more competitive? Should I not be looking at any academic places for training at all?

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[oldbearprofessor]

So I got my scores back and I did about 15 points worse than my NBME practice exam - my score 5 days out was 228 and I got a 213....

I'm on peds now, and I absolutely love it. I am thinking about doing Peds Heme/Onc or another peds sub-specialty. I am not sure which one yet but I'd like to keep my options open.

Obviously I am busting my butt to do as well as I can on the rotation but I'm afraid that my score will preclude me from going to a place that will allow me to do a fellowship. I am not looking for a super-academic career, so I don't need to do it at CHOP or anything. But I'd like to do it at an academic place where I'd have a shot at a couple sub-specialties and hopefully practicing in an environment where I can do some teaching.

How can I make myself more competitive? Should I not be looking at any academic places for training at all?

Assuming you are a US medical student you will have plenty of options for residency in excellent academic institutions. The very top 5-10 programs will be a stretch (though not necessarily impossible), but most other places will be open. It will be helpful to have a higher STEP 2 score before you apply but not crucial.

Relax, do well on your core and especially electives in pedi and you'll be fine. Most pedi fellowships are not that competitive, even at top institutions so you'll have plenty of options from many residency programs in pedi.

 

[shaggy alfresco]

Thank you, that helps. Yes, I am a US MD student.

 

[Siverhideo1985]

http://studentdoctor.net/2011/05/the-successful-match-getting-into-pediatrics/

Good interview/article about getting into a peds residency. She talks about step 1 & 2 scores and how they fit into the big picture of your application.

All is not lost, far from it. You'll find a place you click with and that will open all the doors that are important for you.

 

[Rutgers06]

So I got my scores back and I did about 15 points worse than my NBME practice exam - my score 5 days out was 228 and I got a 213....

I'm on peds now, and I absolutely love it. I am thinking about doing Peds Heme/Onc or another peds sub-specialty. I am not sure which one yet but I'd like to keep my options open.

Obviously I am busting my butt to do as well as I can on the rotation but I'm afraid that my score will preclude me from going to a place that will allow me to do a fellowship. I am not looking for a super-academic career, so I don't need to do it at CHOP or anything. But I'd like to do it at an academic place where I'd have a shot at a couple sub-specialties and hopefully practicing in an environment where I can do some teaching.

How can I make myself more competitive? Should I not be looking at any academic places for training at all?

Like OBP said, all is not lost. My step 1 score was right around what yours was, but I did very well during 3rd year, did a lot better on step 2 (like 30-35 points better), got awesome letters of recommendations and did some other stuff to demonstrate my interest in pediatrics. I applied broadly because I didn't know what to expect, ended up getting interviews at almost every single program, including some of the big kahuna's like Boston Children's and CHOP, and ended up at my #1 ranked program.

Don't let your step 1 score bum you out too much and make sure you do the best you can during 3rd and the beginning of 4th year and you should do fine. There are plenty of great programs out there that will get you where you want to go and you'll still have a shot at academic programs. If possible, I would recommend meeting with a pediatrics advisor or mentor to get a realistic idea of where you stand and what will help your application. I met up with my school's peds program director and it was really useful. If you have any specific questions about my experience, feel free to PM me. Congrats on choosing pediatrics, it's an awesome specialty!

 

[mvenus929]

My step 1 score wasn't a whole lot higher than yours, definitely below the national average. I always get nervous when talking to faculty about the score, but I did a whole lot better on Step 2 (like nearly 40 points higher), and my adviser tells me that for most peds programs, the Steps are just a checkbox on the application, and that they care far, far more about other things on your application, and especially the interview.

 

[southernpedsres]

I'm a current peds resident- I got a 195 on Step 1 and a 240 on Step 2. I felt exactly the same walking out of both tests.

I got my first choice for residency. I was also a really, really good med student. I knew my patients. I was never in it for the grades but to learn. I also had great letters (I saw two of them, remember the waiver only waives your right to see them, not the letter writer's right to voluntarily show you the letter. I was honest with any interviewer who asked that I had seen the letters)

What I mean by all of this is...you'll do fine. Learn a lot. Make a good impression. No one will care about your step 1 score.

 

[shaggy alfresco]

Thanks guys, this is EXTREMELY helpful and calming. As a guy who doesn't want children of my own, I did not come in thinking I'd like pediatrics (though I've always been good with kids), but I feel so excited to go into work every day and love interacting with the families. Then I got my step I score and got worried that I couldn't do what I believe is my 'calling' (yea, I know that's very cheesy but I've had other careers, and shadowed other specialties - I've NEVER felt this excited every day even as a student where I don't know anything). When I found out my score, I felt almost nauseous to think I might be very limited in doing what I want (I mean I wasn't ever going for surg/derm/plastics, but I was hoping to train at a decent place that would afford opportunities for fellowship or an academic career if I chose). It's nice to hear that such doors aren't closed for me.

Right now so many pediatric subspecialties sound fun (I might do general peds too, but since I am not sure, I just want to make sure I keep my options open).

I appreciate all of your help . Thank you again.

On a random note, aside from the students, I am often the only guy on the floor (residents, physicians, nurses, etc) - which is very interesting experience. I don't mind it and I haven't really experienced any aversion to being a guy but it's hilarious how many conversations I just have to sit back and shut up about (sort of like how women must feel in some surgery sub specialties, except unlike them, no one has been mean to me at all). Is the specialty mostly women these days or is where I am an outlier?

 

[oldbearprofessor]

Is the specialty mostly women these days or is where I am an outlier?

The exact numbers for residents and current practitioners is on various AAP, etc websites. Generally about 70-80% of incoming residents are female and this number is relatively constant in recent years. In specialties there are generally a slightly higher to significantly higher number of guys. Neo is about 50:50 and I believe pedi cards has more males than females.

There are no serious issues with being a male pediatrician - this has been covered many times in this forum if you want to search. Some families prefer a general pediatrician who has children, but not everyone cares and this doesn't apply to specialists.

 

[umass rower]

To add on my own experience, I don't remember the exact numbers, but I barely passed Step I and did better, but still below average, on Step II CK. Of all the places where I applied for residency, there were 2 that didn't interview me (one of which didn't surprise me because it's an extremely competitive residency), but got interviews everywhere else and I still matched very well. The subject never came up on interviews. I ended up passing Step III with no problem and was well above average on the Peds boards. I'm currently in the fellowship of my choice in the location of my choice, and all the other residents from my year matched to their #1 fellowship choices (if they had one).

People freak out about the USMLEs because they give you a number to perseverate over, but I suspect very few programs grade applicants based on them, and instead use it as a barometer of whether you can pass future multiple-choice tests. Having been involved in at least the fellow applicant selection process, I can tell you that rank decisions are hugely subjective. Core clerkship grades/comments, LORs, and the actual interview are going to be the top 3 selection criteria pretty much everywhere.

 

[slford00]

I'll offer my input and personal experience, which is consistent with what everyone else in this forum has said. I passed Step 1 on my first attempt but did horribly (lower score than what anyone else has posted on here), did exactly average on Step 2 (225 - a significant improvement over my Step 1), and then did above average on Step 3 (235). I had an average GPA in med school (middle of my class) but did excellent in my Peds rotations and had very strong letters.

When I applied to residency only two places I applied didn't offer me interviews, and one of them was Cincy, which I wasn't suspecting an offer from but appiled to due to proximity (my wife was tied to the area at the time). The subject of my Step 1 only came up in 1 of my 8 interviews for residency, and I matched at my #1 choice.

I'm currently a third year in Peds and have applied for NICU fellowship, which is one of the more competitive Peds fellowships but still not very competitive overall (compared to residency or some adult fellowships). I've received interview offers at all the places I'm interested in going to, including 7-8 at top 10-20 programs--I had to turn a few down due to scheduling logistics. I haven't matched yet (will in October) but I feel reasonably confident about my chances of getting one of my top 2-3 choices.

The points that I'm making, which are consistent with my anecdotal experience as well as the other posts in this thread, are that:

1) If you are going to pick a specialty where a bad Step 1 score isn't going to kill you, Peds is one of your best bets -- in general, all but the very top programs care about other (IMHO, more important) things than Step scores

2) You will be able to match in any Peds fellowship you want, at an excellent training program, likely no matter where you go for residency. It's simple supply and demand--there are more spots for Peds fellowship positions than there are applicants -- NICU, PICU, Cards it's about 1:1 spots:applicants (give or take a dozen spots), and for all the rest, including the ones you've expressed interest in, the available spots far outnumber the applicants.

Good luck, don't stress out too much, do well in your rotations/interviews, and congratulations on making the right choice and picking the best specialty to go into ;-)

 

[shaggy alfresco]

Thanks guys! I did honor my Peds but not with a great shelf score. I did IM next and I don't think I will honor that, though I tried hard. We'll see.

I am wondering (re: fellowship opportunities) - how can I decide which programs to apply to with a view towards the fellowships I wanted (PICU, Heme)? Places I'm looking at online have anywhere between 20-60% of people doing fellowships - is that a good gauge to the ability of said programs to match their residents or merely reflects the preferences of the residents themselves?

 

[umass rower]

I am wondering (re: fellowship opportunities) - how can I decide which programs to apply to with a view towards the fellowships I wanted (PICU, Heme)? Places I'm looking at online have anywhere between 20-60% of people doing fellowships - is that a good gauge to the ability of said programs to match their residents or merely reflects the preferences of the residents themselves?

The generic answer is that you can pretty much do any specialty coming from any program, assuming you take all the necessary steps (showing interest, doing an elective, getting to know the attendings, etc.). While some programs tilt more toward primary care or specialties, I don't recall seeing many programs where more than about half the residents went into fellowship, and for the most part it seemed to be more or less self-directed (as in, people went into primary care because that's what they wanted to do, not because they couldn't get into fellowship). I might steer clear of places with teeny-tiny programs or only like 1 faculty member in your specialty of choice, but this is mostly an issue of learning opportunities and practical concerns. It may help to have someone with name recognition in their field, but this doesn't necessarily mean you have to go to a big center, and this can be hard to figure out before actually being in that field.

 

[Stitch]

The generic answer is that you can pretty much do any specialty coming from any program, assuming you take all the necessary steps (showing interest, doing an elective, getting to know the attendings, etc.). While some programs tilt more toward primary care or specialties, I don't recall seeing many programs where more than about half the residents went into fellowship, and for the most part it seemed to be more or less self-directed (as in, people went into primary care because that's what they wanted to do, not because they couldn't get into fellowship). I might steer clear of places with teeny-tiny programs or only like 1 faculty member in your specialty of choice, but this is mostly an issue of learning opportunities and practical concerns. It may help to have someone with name recognition in their field, but this doesn't necessarily mean you have to go to a big center, and this can be hard to figure out before actually being in that field.

Agreed. On top of that, your interests may change over the course of your training. So go to a place that gives solid general peds education (which is just about anywhere) with good exposure to subspecialties. Most sub specialists will be fairly well connected and can advise you on how to get into said fellowship. It's much more important for you to be happy and work hard during residency (I firmly believe that being happy makes work easier, and makes people more inclined to do their best). That way you can get strong letters of recommendation.

 

[RecordedLoop]

I was actually wondering the same thing but for a DO student. Is it harder with a low COMLEX I score? I barely passed my COMLEX I but did over a 100 points higher on COMLEX LEVEL II. I feel like I am hitting a wall with interviews. My grades are decent, first 2 years were pass/fail for me and I HP every rotation 3rd year with an Honors in Peds. I do pretty well clinically, and I have 3 letters of rec. 1 I know for sure is strong, the other two I haven't seen so I wouldn't know. But I feel like I'm being locked out of interviews in the northeast, which is where I would like to stay.

 

[shaggy alfresco]

Did you take the USMLE? If you are applying to MD schools that don't normally take a lot of DOs, they may not know how to gauge COMLEX scores compared to their MD applicants. I'm not in a DO school but that's what I've been told by some DO friends of mine.

 

[RecordedLoop]

I did not take the USMLE. I was planning to take both, but I really need to study for the exam itself and figure out how they ask questions. As I was studying for USMLE and my score was gradually going up, my COMLEX score did not move and that is what I needed to pass to graduate. I decided to shift my focus and give up on USMLE. So I only took COMLEX I and II, doing over 130 pts better on Level II

 

[thefritz]

Oh, come on. You got a 213, over 20 points above passing, and you want to go into one of the least competitive specialties with lowest step 1 average. I"m just curious, if you think you couldn't match into peds because of your step 1, what would you do then?

 

[Dral]

Oh, come on. You got a 213, over 20 points above passing, and you want to go into one of the least competitive specialties with lowest step 1 average. I"m just curious, if you think you couldn't match into peds because of your step 1, what would you do then?

I don't think that is the OP's concern. It seems they were more worried about being able to match at a good enough program to have the best shot at fellowship. It seems that's not really an issue either.

 

[shaggy alfresco]

Oh, come on. You got a 213, over 20 points above passing, and you want to go into one of the least competitive specialties with lowest step 1 average. I"m just curious, if you think you couldn't match into peds because of your step 1, what would you do then?

I'm not worried about matching 'somewhere', but that wasn't my goal. I want to do it at a place that offers a decent chance at getting into a fellowship (preferably an in house one). It sounds like that won't be a big issue.